MEDICARE: TIMOTHY P CEYNOWA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	27823	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518959915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY P CEYNOWA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 5074
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5074
Country	:	US
Telephone Number	:	605-328-9556
Fax Number	:	605-328-9501

Provider Business Practice Location Address
First Line	:	1601 SIOUX VALLEY DRIVE
Second Line	:
City	:	LUVERNE
State	:	MN
Zip	:	56156
Country	:	US
Telephone Number	:	507-283-4476
Fax Number	:	507-283-9086

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	05/08/2008

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